1
|
Zou B, Tu Y, Liao D, Xu Y, Wang J, Huang M, Ren L, Zhu J, Gong Y, Liu Y, Zhou L, Zhou X, Peng F, Lu Y. Radical esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma followed by adjuvant radiotherapy with or without chemotherapy: Which is more beneficial? Thorac Cancer 2020; 11:631-639. [PMID: 31943824 PMCID: PMC7049519 DOI: 10.1111/1759-7714.13307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 02/05/2023] Open
Abstract
Background This retrospective study compared the efficacy and side effect profile between postoperative adjuvant radiotherapy and chemoradiotherapy in stage II or stage III thoracic esophageal squamous cell carcinoma (TESCC) patients who underwent curative (R0) esophagectomy. Methods A total of 272 TESCC patients who underwent radical esophagectomy from 2007 to 2016 were included in this retrospective analysis. All cases were pathologically confirmed with stage II or III disease and 148 patients received postoperative chemoradiotherapy (CRT), while the remaining 124 patients received postoperative radiotherapy (RT) alone. Results In CRT and RT groups, the three‐year overall survival rates were 51.3 versus 31.5% (P < 0.01) and the median overall survival (OS) was 39 months (95% CI, 31.6 to 46.3 months) and 30 months (95% CI, 21.0 to 38.9 months), respectively (P = 0.213). Three‐year disease‐free survival rates (DFS) were 30.5% versus 15.9% (P = 0.008), while the median DFS times were 26 months (95% CI, 17.7 to 34.3 months) and 19 months (95% CI, 16.4 to 21.6 months), respectively (P = 0.156). Univariate and multivariate analyses showed AJCC (American Joint Committee on Cancer seventh edition) stage and N stage were independent prognostic factors for overall survival, while the N stage was an independent prognostic factor for disease‐free survival. Conclusions Postoperative chemoradiotherapy led to one‐ and three‐year overall survival benefits along with an obvious increase in treatment side effects for stage II to III TESCC patients, with no further improvement in five‐year survival. However, the chemoradiotherapy benefits mainly favor stage III,number of resected lymph nodes less than 15, younger (less than 60 years old) and smoking patients.
Collapse
Affiliation(s)
- Bingwen Zou
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Yan Tu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China.,Department of Gastroenterology, The First People's Hospital of Kunming, Kunming, China
| | - Duwen Liao
- Department of Gastroenterology, The First People's Hospital of Kunming, Kunming, China
| | - Yong Xu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Jin Wang
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Meijuan Huang
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Li Ren
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Jiang Zhu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Youling Gong
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Yongmei Liu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Lin Zhou
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Xiaojuan Zhou
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Feng Peng
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - You Lu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Nobel TB, Curry M, Gennarelli R, Jones DR, Molena D. Higher clinical suspicion is needed for prompt diagnosis of esophageal adenocarcinoma in young patients. J Thorac Cardiovasc Surg 2019; 159:317-326.e5. [PMID: 31126651 PMCID: PMC6801049 DOI: 10.1016/j.jtcvs.2019.03.095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/13/2019] [Accepted: 03/31/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Esophageal cancer is considered a disease of the elderly. Although the incidence of esophageal adenocarcinoma in young patients is increasing, current guidelines for endoscopic evaluation of gastroesophageal reflux disease and Barrett's esophagus include age as a cutoff. There is a paucity of data on the presentation and treatment of esophageal cancer in young patients. Most studies are limited by small sample sizes, and conflicting findings are reported regarding delayed diagnosis and survival compared with older patients. METHODS A retrospective cohort study was performed using the National Cancer Database between 2004 and 2015. Patients with esophageal adenocarcinoma were divided into quartiles by age (18-57, 58-65, 66-74, 75+ years) for comparison. Clinicopathologic and treatment factors were compared between groups. RESULTS A total of 101,596 patients were identified with esophageal cancer. The youngest patient group (18-57 years) had the highest rate of metastatic disease (34%). No difference in tumor differentiation was observed between age groups. Younger patient groups were more likely to undergo treatment despite advanced stage at diagnosis. Overall 5-year survival was better for younger patients with local disease, but the difference was less pronounced in locoregional and metastatic cases. CONCLUSIONS In this study, young patients were more likely to have metastatic disease at diagnosis. Advanced stage in young patients may reflect the need for more aggressive clinical evaluation in high-risk young patients.
Collapse
Affiliation(s)
- Tamar B Nobel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Environmental Medicine and Public Health, Mount Sinai Hospital, New York, NY
| | - Michael Curry
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Renee Gennarelli
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| |
Collapse
|
3
|
Gai W, Jin XF, Du R, Li L, Chai TH. Efficacy of narrow-band imaging in detecting early esophageal cancer and risk factors for its occurrence. Indian J Gastroenterol 2018. [PMID: 29516416 DOI: 10.1007/s12664-017-0813-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the efficacy of narrow-band imaging (NBI) in the detecting early esophageal cancer and precancerous lesions and to investigate the risk factors for its occurrence. METHODS The esophagus was examined with ordinary endoscopy, NBI, and iodine staining. All the lesions were confirmed by histopathologically as the gold standard; NBI and intrapapillary capillary scale (IPCL) scale were compared with pathologic diagnosis. The accuracy, sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated. Subgroup analysis was performed between the elderly vs. younger group, and head and neck squamous cell cancer (HNSCC) vs. non-HNSCC patients. RESULTS Ninety lesions were detected with ordinary endoscopy, 108 with NBI, and 120 with iodine staining. All esophageal cancers were detected both by NBI and by iodine staining. Accuracy, sensitivity, and specificity for esophageal cancer and precancerous lesion were 67.8%, 58.1%, and 76.6%; 92%, 89.7%, and 96%; 93.4%, 93.4%, and 93.2%, respectively. NBI endoscopy and iodine staining were superior to ordinary endoscopy for detecting esophageal cancer and precancerous lesions (p < 0.05). NBI showed better detection of esophageal neoplasms in the elderly patients (p < 0.001). The incidence of multiple squamous cell cancers (SCCs) was significantly higher in non-elderly group (p = 0.009). NBI can also detect more esophageal neoplastic lesions in patients with head and neck cancers (p = 0.003). CONCLUSIONS NBI endoscopy appears as effective as Lugol staining to detect and screen the early esophageal cancer. NBI shows better detection of esophageal neoplasms in the elderly patients. The incidence of multiple SCCs was much higher in non-elderly patients.
Collapse
Affiliation(s)
- Wei Gai
- Department of Gastroenterology, Tengzhou Central People's Hospital, 183 Xingtan Road, Tengzhou, Shandong Province, 277500, China
| | - Xi-Feng Jin
- Department of Gastroenterology, Tengzhou Central People's Hospital, 183 Xingtan Road, Tengzhou, Shandong Province, 277500, China. .,Department of Internal Medicine, University-Hospital Campus Grosshadern, Ludwig-Maximilian University of Munich, Munich, Germany.
| | - Ronglian Du
- Department of Gastroenterology, Tengzhou Central People's Hospital, 183 Xingtan Road, Tengzhou, Shandong Province, 277500, China
| | - Ling Li
- Department of Gastroenterology, Tengzhou Central People's Hospital, 183 Xingtan Road, Tengzhou, Shandong Province, 277500, China
| | - Tong-Hai Chai
- Department of Gastroenterology, Tengzhou Central People's Hospital, 183 Xingtan Road, Tengzhou, Shandong Province, 277500, China
| |
Collapse
|
4
|
Kasagi Y, Morita M, Otsu H, Kawano H, Ando K, Hiyoshi Y, Ito S, Miyamoto Y, Saeki H, Oki E, Maehara Y. Clinicopathological characteristics of esophageal squamous cell carcinoma in patients younger than 50 years. Ann Surg Oncol 2014; 22:311-5. [PMID: 24962939 DOI: 10.1245/s10434-014-3856-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE This study clarifies age differences in clinicopathologic characteristics and risk factor exposure of patients who have undergone esophagectomy for esophageal cancer (EC). METHODS Clinical results of esophagectomy were compared between 22 patients younger than 50 years of age (Group I) and 327 patients older than 50 years of age (Group II) with esophageal squamous cell carcinoma. RESULTS The two groups did not significantly differ in clinicopathological characteristics, including prognosis. Postoperative pulmonary complication incidence rates were 4.2 % (Group I) and 14.4 % (Group II). In Group I, the incidence of multiple ECs was 36.4 %, and association with head and neck cancer was 31.8 %, which were significantly higher than in Group II (13.4 %, p = 0.021; and 9.2 %, p = 0.015, respectively). Furthermore, the patients in Group I with multiple cancers were almost all heavy smokers and/or users of alcohol. CONCLUSIONS These results suggest that multiple upper aerodigestive tract cancers are associated with heavy exposure to risk factors in patients younger than 50 years of age.
Collapse
Affiliation(s)
- Yuta Kasagi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
van Nistelrooij AMJ, van Steenbergen LN, Spaander MCW, Tilanus HW, van Lanschot JJB, Lemmens VEPP, Wijnhoven BPL. Treatment and outcome of young patients with esophageal cancer in the Netherlands. J Surg Oncol 2013; 109:561-6. [PMID: 24338660 DOI: 10.1002/jso.23533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/20/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND Esophageal cancer is increasingly recognized in younger patients. We compared clinicopathological characteristics, treatment, and survival of patients aged ≤50 years with patients aged >50 years diagnosed with esophageal cancer in the Netherlands. METHODS From the nationwide Netherlands Cancer Registry we identified all patients diagnosed with esophageal cancer between January 2000 and January 2011. Proportions were compared using the χ(2) test for categorical variables. Overall and relative survival was calculated. RESULTS Eleven percent of the patients (n = 1,466) were aged ≤50 years and adenocarcinoma was the most common tumor type (73.6%). Grade of tumor differentiation was comparable between both age groups (P = 0.460) as well as T-stage (P = 0.058). Younger patients presented more often with positive lymph nodes (70.1% vs. 66.4%, P = 0.010) and distant metastasis (50.5% vs. 44.7%, P < 0.001) but had surgery more often as compared to older patients: 40.6% versus 37.9%, P = 0.047. There was no significant difference in the 5-year relative survival between both age groups: 18.1% versus 17.2%, P > 0.05. A subgroup analysis among patients diagnosed with adenocarcinoma revealed similar results. CONCLUSIONS Young patients with esophageal cancer present with more advanced disease stage and received more often treatment. However, they show comparable relative survival rates with their older counterparts.
Collapse
|